EXERCISE HEALTH BENIFITS Joel Baumgartner MD

1. Joel Baumgartner MD EXERCISE HEALTH BENIFITS Joel Baumgartner MD

2. Why Should I Exercise?? Overweight and Out of shape people: Die young Premature disability Increased cancer risk Increased chronic disease risk DM, Heart dz, Stroke, HTN Lower good hormone levels Testosterone, DHEA, Progesterone, Growth Hormone Higher bad hormone levels Estrogen, Insulin

3. What happens with weight gain? • CARDIOVASCULAR • hardening of the arteries • increased blood pressure • heart enlarges • O2 uptake decreases (VO2Max)

4. What happens with weight gain? • BRAIN • neuronal cell loss • decreased reaction time • decreased balance • Depression increases/Motivation decreases

5. What happens with weight gain and aging? • MUSCLE • Muscle mass /Strength Decreases • Maintained to 5th decade • Decreases 15% per decade after age 50 • Decreases 30% per decade after age 70

6. What happens with weight gain? • SKELETAL • Decreased joint motion • Stiffness and aches • Increased arthritis

7. What happens with weight gain? • HORMONES • Increased INSULIN • storage hormone-increased FAT

8. What happens with weight gain? • Increased ESTROGEN • FAT increases Estrogen through Aromatase • Bloating Fatigue Headaches • Water retention Mood swings Irritability • Increased Cancer Weight gain

9. What happens with weight gain? • Decreased GROWTH HORMONE/TESTOSTERONE • Needed for metabolism and muscle growth

10. MENOPAUSE and WEIGHT GAIN • Leads to imbalance of hormones • E1, E2, E3, Progesterone, DHEA, Testosterone, Cortisol • Higher stress and Cortisol levels lead to weight gain • FAT increases E1-leads to increase risk of breast cancer

11. BENEFITS of Exercise and Weight Loss • Cardiovascular • DM type 2 • Osteoporosis • Osteoarthritis • Neuropsychologic • Cancer • Other……..

12. Benefits CARDIOVASCULAR • Improves physiologic parameters • VO2 max and CO • Improves blood pressure • Decrease risk for CADz • Improves CHF symptoms • Improves Cholesterol profiles • increases HDL/decreases LDL

13. Benefits LEAN MUSCLE AND STRENGTH • Most dramatic benefits seen • Strength gains similar to younger training individuals • Classic Study • 10 frail NH residents-8wks of weight training • All had increased strength • mean of 74% in quadriceps • gait speed increased 50% • 2 no longer needed canes to walk

14. Benefits DM Type 2 • Decrease incidence (36%) • Physicians Health Study • Improves control of sugars • Decreases HgA1c levels • Improves insulin sensitivity

15. Benefits OSTEOARTHRITIS • FAST (Fitness and Arthritis in Seniors Trial) • Improves function • Decreases pain • No increase in overall injuries • Resistance training increased: • speed, strength, and stair climbing

16. Benefits MENTAL HEALTH • Improves sleep quality • Improves cognitive function • Decreased rates of depression • Improves short term memory! • Exercise HIGH

17. Benefits HORMONES Increased GH and Testosterone Study show after a cardio workout or resistance workout anabolic hormones remain elevated for hours after Decreased Fat Decreased Aromatization and Estrogens (Estrogen maintains fat stores) Male and Female

18. BenefitsCANCER • Potential decrease risk • Colon, Breast, Prostate and Rectum • Improves quality of life • Decreased fatigue

19. Benefits Other….. • Decrease all cause mortality • Decrease all cause morbidity • Decrease risk of obesity • Improves circulation and symptoms of PVDz

20. Is it Too Late? • NO!!!! • Even if start program after age 75 • Reduced overall mortality rates • Resistance training can still increases strength by 25-100% • Increased muscle strength • Increased coordination

21. Before Jumping into It... • Preparticipation Screening • Cardiovascular risks • Exertional sign/symptoms • Physical limitations

22. Do I need a Stress Test? • Men >=45 years and women >=55 years who plan to exercise at >=60%VO2 max • Known CAD or cardiac symptoms • Two or more CAD risk factors* • HTN, Smoker, Cholesterol, Obese, Sedentary, Family history of early CAD • Diabetes • Known or major signs/symptoms of pulmonary or metabolic disease

23. What do I need to do? • Cardiovascular • Strength • Balance and Flexibility

24. Cardiovascular • Moderate Aerobic Activity • At least 30 minutes most days of the week • individual bouts as brief as 10 minutes

25. Strength • Single set of 10-15 repetitions • Do 8-10 different exercises • 3 times a week • Perform slowly, entire ROM • DO NOT Hold breath • Involve all major muscle groups • Be patient-6wks to see changes

26. Balance and Flexibility • Stretch major muscle groups • after exercise (muscle more compliant) • Balance and weight transfer program • twice a week

27. How should I start aerobic training? • Sedentary people should start slow • Gradually progress to moderate activity • “Talk Test” • Warm up and cool down • 5-10 min of less intense activity • slow walking, balance or stretching

28. Moderate Aerobic Exercise • Brisk walk (3-4mph) • Cycling leisurely (around 10mph) • Social Dancing

29. Moderate Aerobic Exercise • Doubles tennis • Golf-using a pull cart

30. Moderate Aerobic Exercise • Fishing -stand and cast • Canoeing leisurely (2-4mph)

31. Moderate Aerobic Exercise • Mowing lawn • Home repair, painting

32. What about starting weight training? • Start slow and increase weight • 2 pounds or a soup can to start • elastic bands • repetitive rising from a chair • increase weight till able to perform 10-15 before fatigue • to obtain significant gains in strength

33. What a about stretch and balance program? • Should start before aerobic training if deconditioned • One leg balancing • Stop if feel pain • DYNAMIC WARMUP • Stretch after each workout • Holding positions for at least 30 seconds

34. Oh, I can’t do that…. • How to get around the ROAD BLOCKS

35. Road Block 1Self-efficacy: Can I do it? • Start slowly with easy exercise • Advance gradually-build confidence • Get frequent encouragement • Work out with a group or a friend • Get a good Personal Trainer

36. Road Block 2Attitude • Promote the positive benefits • Find enjoyable activities • Use music you like • Find a partner

37. Road Block 3 Discomfort • Vary the intensity and exercises • Employ cross training • Allow rest and overdoing • Try the water

38. Road Block 4Disability • Specialized exercises • Personal trainer or PT • Again get to the water

39. Road Block 5Poor Balance/Ataxia • Assistive devices • increase safety • increase intensity

40. Road Block 6Fear of Injury • Balance and Strength training first • Use appropriate clothing, equipment, and trainer supervision • Loose fitting clothes • sturdy, well-fitting shoes • good arch • cushioned heel to absorb shock • Start slowly

41. Road Block 8Habit • Incorporate into daily routine • build onto the OLD routine • put weights, step-ups or machines near TV • Promote active lifestyle changes • push mover • pull golf cart • park away • gardening • take the stairs

42. Road Block 9Environmental factors • Walk in mall • Fitness center • Promote active lifestyles at home • Educate family and friends about benefits

43. Road Block 10Illness/Fatigue • Adjust intensity to meet energy levels • Light exercise stimulates immune system

44. What about my meds? • Antihypertensive (BB and CCB) • bradycardia and mask hypoglycemia • Diuretics • dehydration, electrolytes, cramping • Insulin and sulfonylureas • hypoglycemia • Anticoagulants • bleeding with falls or injury

45. MD FITMode: Pick activities you enjoy Strength, Endurance, FlexibilityDuration: 30 to 40 minutesFrequency: Most days of the weekIntensity: Low to high depending on fitnessTimely Follow up: See physician for monitoring and encouragementJBaumgartner

46. Call your doctor... • Chest pain or pressure • Trouble breathing or SOB • Light-headedness of dizziness • Difficulty with balance • Nausea

47. The Finish Line • Any additional activity is beneficial • Start slow and gradually increase • Build on activities you enjoy • Work out with a partner or Trainer • Improve your NUTRITION!!!